DAANCE Patient Monitoring Techniques 5 — Questions and Answers
Question 1: A patient sedated with nitrous oxide/oxygen begins showing signs of dysphoria and restlessness. The MOST appropriate immediate action is to:
- Increase the nitrous oxide concentration
- Decrease the nitrous oxide concentration and increase oxygen (Correct answer)
- Administer reversal agent flumazenil
- Place the patient in Trendelenburg position
Correct answer: Decrease the nitrous oxide concentration and increase oxygen
Dysphoria and restlessness during nitrous oxide sedation indicate an adverse reaction; reducing N2O and increasing O2 is the first corrective step.
Question 2: Which parameter is MOST useful for detecting early airway obstruction in a sedated patient?
- Blood pressure
- Heart rate
- Capnography waveform (Correct answer)
- Skin color
Correct answer: Capnography waveform
Capnography detects changes in ventilation before SpO2 drops, making it the earliest indicator of airway obstruction.
Question 3: During moderate sedation monitoring, the assistant notes a sudden drop in heart rate to 42 bpm in an adult patient. This finding is MOST consistent with:
- Sympathetic stimulation
- A vasovagal episode (Correct answer)
- Hyperthermia
- Opioid-induced tachycardia
Correct answer: A vasovagal episode
Profound bradycardia accompanied by hypotension is classic for a vasovagal episode, often triggered by pain, anxiety, or needle phobia.
Question 4: The correct cuff size for NIBP monitoring requires that the bladder width cover approximately what percentage of the patient's upper arm circumference?
- 20–30%
- 40%
- 50–80% (Correct answer)
- 90–100%
Correct answer: 50–80%
The AHA recommends that the bladder width cover 40% and the bladder length cover 80% (approximately 50–80%) of the arm circumference for accurate readings.
Question 5: Which of the following signs of airway obstruction would be detected by a precordial or pretracheal stethoscope but NOT by pulse oximetry alone?
- Decreased SpO2
- Snoring or stridor breath sounds (Correct answer)
- Cyanosis of the lips
- Slowed capillary refill
Correct answer: Snoring or stridor breath sounds
Snoring and stridor are auditory signs of partial airway obstruction detectable via stethoscope before oxygen saturation falls on pulse oximetry.
Question 6: In a DAANCE-level monitoring protocol, how frequently should baseline vital signs be recorded before administering IV sedation?
- Once, at the start of the appointment
- Every 30 minutes throughout the appointment
- At minimum before sedation and every 5 minutes during the procedure (Correct answer)
- Only if the patient reports symptoms
Correct answer: At minimum before sedation and every 5 minutes during the procedure
Baseline vitals must be documented before sedation, then monitored at least every 5 minutes during the procedure per AAPD/ADA sedation guidelines.
Question 7: A patient's SpO2 reading on the finger probe is 94% but the patient appears pink and comfortable. Which factor is MOST likely causing this discrepancy?
- The patient is in early respiratory failure
- Nail polish or poor peripheral perfusion is interfering with the probe (Correct answer)
- The patient has undiagnosed carbon monoxide poisoning
- The oxygen flowmeter is malfunctioning
Correct answer: Nail polish or poor peripheral perfusion is interfering with the probe
Dark nail polish, acrylic nails, or poor peripheral perfusion (cold fingers, vasoconstriction) are common causes of falsely low SpO2 readings.
DAANCE Patient Monitoring Techniques 5
A patient sedated with nitrous oxide/oxygen begins showing signs of dysphoria and restlessness.
The MOST appropriate immediate action is to: